Linking Childhood Interpersonal Adversity, Attachment Style, and the Subclinical Psycho

236 Pages·2014·1.81 MB·English

Universitat Autònoma de Barcelona
Facultat de Psicologia
Departament de Psicologia Clínica i de la Salut
Doctorat en Psicologia Clínica i de la Salut

Doctoral Thesis

The Salience of Relational Experiences:
Linking Childhood Interpersonal Adversity, Attachment Style, and the
Subclinical Psychosis Phenotype

by
Tamara Sheinbaum Frank

Supervisor:
Prof. Neus Barrantes-Vidal

Bellaterra (Barcelona)
September 2014

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CONTENTS
1. INTRODUCTION.....................................................................................................................9
2. BACKGROUND ....................................................................................................................13
2.1. The Continuum Model of Schizotypy and Schizophrenia ................................................13
2.1.1. The Multidimensional Structure of Schizotypy, its Assessment, and Validity ............14
2.2. Psychosocial Risk Factors for Schizotypy and Schizophrenia: The Case of Childhood
Interpersonal Adversity..........................................................................................................15
2.2.1. Measurement of Childhood Interpersonal Adversity .................................................17
2.2.2. Plausible Mechanisms to Explain the Adversity—Psychosis Link ............................17
2.3. Attachment Theory .........................................................................................................18
2.3.1. The Attachment Style Construct ..............................................................................20
2.3.2. Measurement and Validity of Attachment Styles .....................................................22
3. AIMS AND OUTLINE OF THIS THESIS ...............................................................................25
References ............................................................................................................................28
4. EMPIRICAL WORK
SECTION 1: ATTACHMENT ....................................................................................................39
Chapter 1: Spanish version of the Psychosis Attachment Measure: Adaptation process and
psychometric properties ............................................................................................................41
Summary...............................................................................................................................42
Introduction ...........................................................................................................................44
STUDY 1 ...............................................................................................................................46
Overview ...........................................................................................................................46
Method ..............................................................................................................................47
Results ..............................................................................................................................48
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Discussion .........................................................................................................................49
STUDY 2 ...............................................................................................................................50
Overview ...........................................................................................................................50
Method ..............................................................................................................................50
Results ..............................................................................................................................51
Discussion .........................................................................................................................52
General Discussion ...............................................................................................................53
Tables and Figures ...............................................................................................................56
References ............................................................................................................................59
Chapter 2: Real-life expression of adult attachment styles ........................................................65
Abstract .................................................................................................................................66
Introduction ...........................................................................................................................67
Methods ................................................................................................................................72
Results ..................................................................................................................................74
Discussion.............................................................................................................................77
Tables and Figures ...............................................................................................................83
References ............................................................................................................................88
SECTION 2: SCHIZOTYPY ......................................................................................................93
Chapter 3: Positive and negative schizotypy are associated with prodromal and schizophrenia-
spectrum symptoms ..................................................................................................................95
Abstract .................................................................................................................................96
Introduction ...........................................................................................................................97
Methods ................................................................................................................................99
Results ................................................................................................................................ 101
Discussion........................................................................................................................... 104
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Tables ................................................................................................................................. 110
References .......................................................................................................................... 113
SECTION 3: ATTACHMENT AND SCHIZOTYPY .................................................................. 119
Chapter 4: Association between attachment prototypes and schizotypy dimensions in two
independent non-clinical samples of Spanish and American young adults .............................. 121
Abstract ............................................................................................................................... 122
Introduction ......................................................................................................................... 123
Methods .............................................................................................................................. 127
Results ................................................................................................................................ 129
Discussion........................................................................................................................... 130
Tables ................................................................................................................................. 135
References .......................................................................................................................... 138
SECTION 4: MEDIATING MECHANISMS IN THE LINK BETWEEN CHILDHOOD
INTERPERSONAL ADVERSITY AND THE SUBCLINICAL PSYCHOSIS PHENOTYPE: THE
ROLE OF ATTACHMENT STYLE .......................................................................................... 147
Chapter 5: Mechanisms mediating the pathway from environmental adversity to psychosis
proneness ............................................................................................................................... 149
Abstract ............................................................................................................................... 150
Introduction ......................................................................................................................... 151
Candidate Environmental Factors ....................................................................................... 152
Mediating Mechanisms........................................................................................................ 154
Conclusions and Future Directions ...................................................................................... 164
References .......................................................................................................................... 168
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Chapter 6: Fearful attachment mediates the association of childhood trauma with schizotypy
and psychotic-like experiences ............................................................................................... 175
Abstract ............................................................................................................................... 176
Introduction ......................................................................................................................... 177
Methods .............................................................................................................................. 178
Results ................................................................................................................................ 179
Discussion........................................................................................................................... 180
Table ................................................................................................................................... 182
References .......................................................................................................................... 183
Chapter 7: Interview investigation of insecure attachment styles mediating between poor
childhood care and schizophrenia-spectrum psychopathology ................................................ 187
Abstract ............................................................................................................................... 188
Introduction ......................................................................................................................... 189
Material and methods .......................................................................................................... 191
Results ................................................................................................................................ 194
Discussion........................................................................................................................... 195
Tables ................................................................................................................................. 200
References .......................................................................................................................... 204
5. GENERAL DISCUSSION ................................................................................................... 209
5.1. Summary of Findings ................................................................................................... 209
5.2. Integration and Theoretical Implications ....................................................................... 211
5.3. Implications for Intervention Initiatives and Clinical Work.............................................. 215
5.4. Limitations .................................................................................................................... 216
5.5. Future Directions .......................................................................................................... 217
5.6. Conclusion ................................................................................................................... 219
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References .......................................................................................................................... 221
Acknowledgements ................................................................................................................. 225
CCUURRRRIICCUULLUUMM VVIITTAAEE… ....…...…....…....…...…....…...…....…...…....…...…....…...…....…...…....…...…....…...…....…...…....…....…...…....…...…....…...…....…...…..... 22 2222577

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1. INTRODUCTION

Schizophrenia and related psychotic disorders are among the most severe mental
conditions. They are associated with considerable personal suffering as well as with significant
costs and burden to the individual, the family, and the society at large (Andlin-Sobocki &
Rössler, 2005; Rössler, Salize, van Os, & Riecher-Rössler, 2005; Shah, Mizrahi, & McKenzie,
2011; van Os & Kapur, 2009). The onset of psychotic disorders most often occurs in late
adolescence or early adult life and their lifetime prevalence is estimated at around 3% (Perälä et
al., 2007; van Os & Kapur, 2009). Despite intensive study, their etiology remains incompletely
understood; however, there is accruing work showing that several factors (e.g., genetic,
biological, psychosocial) are contributory and most likely interact in complex ways to produce
vulnerability (Shah, Tandon, & Keshavan, 2013; van Os, Krabbendam, Myin-Germeys, &
Delespaul, 2005; van Os, Kenis, & Rutten, 2010). Understanding how these debilitating
disorders develop is essential for identifying fruitful targets for effective prophylactic and
therapeutic interventions.
Although traditionally medical models have viewed the symptoms of schizophrenia as
categorical entities (i.e., present versus absent), there is growing evidence from multiple lines of
research suggesting that schizophrenia-related phenotypes are better conceptualized as
continuous rather than categorical—with vulnerability extending well beyond the diagnostic
thresholds (Johns et al., 2004; Kwapil, Chapman, & Chapman, 1999; Myin-Germeys,
Krabbendam, & van Os, 2003). Indeed, recent reviews and meta-analyses have shown that a
substantial minority of individuals from the general population experience milder forms of
psychotic symptoms (in the absence of disorder) and that clinically relevant psychosis only
constitutes a small proportion of the phenotypic continuum (Kelleher & Cannon, 2011; van Os,
Linscott, Myin-Germeys, Delespaul, & Krabbendam, 2009; Linscott & van Os, 2013).
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The work presented in this thesis is framed within the continuum model of schizotypy
and schizophrenia. Schizotypy can be conceptualized as the underlying vulnerability for
schizophrenia-spectrum psychopathology that is expressed as a multidimensional personality
disposition with traits distributed across continua of increasing severity (Barrantes-Vidal, Grant,
& Kwapil, in press; Kwapil, Barrantes-Vidal, & Silvia, 2008). Schizotypy provides a useful
construct for understanding the etiology and expression of schizophrenia-spectrum
psychopathology because it subsumes a broad range of conditions (including subclinical and
clinical expressions) under a single conceptual framework that is not constrained by diagnostic
boundaries (Kwapil & Barrantes-Vidal, in press).
Over the last decade, considerable empirical evidence has pointed to the significance of
a range of psychosocial factors in the vulnerability for schizotypy and schizophrenia (Bentall &
Fernyhough, 2008; Nelson, Seal, Pantelis, & Phillips, 2013; van Os et al., 2009; van Os et al.,
2010). One such factor is childhood interpersonal adversity. Exposure to childhood
interpersonal adversity has been consistently associated with psychotic disorders, psychotic
symptoms and experiences, and schizotypy traits (Matheson, Shepherd, Pinchbeck, Laurens, &
Carr, 2013; Varese et al., 2012; Velikonja, Mason, & Fisher, in press). However, knowledge of
the mechanisms underlying this association is still in its infancy, with a limited number of studies
having been designed to identify mechanistic pathways leading to different symptom profiles
(Bentall et al., 2014).
Attachment theory, which emphasizes the crucial role of relational experiences with
respect to adaptation and functioning throughout the lifespan, has been proposed as an
explanatory theory for understanding the link between childhood interpersonal adversity and
psychotic phenomena (Read & Gumley, 2008). Attachment researchers have typically focused
on measuring individual differences in attachment style—a construct that encompasses inner
representations of self and others, affect regulation strategies, and interpersonal functioning
(Mikulincer & Shaver, 2007). Insecure attachment styles have been associated with several
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